title: Vitamin B6 deficiency: a potential cause of refractory seizures in adults.
abstract: OBJECTIVE
  In children, vitamin B(6) (pyridoxine) deficiency has been described as a cause of seizures that are refractory to conventional antiepileptic medications. We describe the clinical presentation of 3 adults with refractory seizures (later diagnosed with vitamin B(6) deficiency) that resolved after pyridoxine treatment.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary care surgical intensive care unit.
  
  
  METHODS
  In the first case, a 54-year-old male with history of alcoholic cirrhosis developed new-onset seizures refractory to phenytoin and levetiracetam 8 days after liver transplantation. In the second case, a 59-year-old male with hepatitis C infection developed intracranial hemorrhage and new-onset seizures refractory to phenytoin, levetiracetam, and pentobarbital. The third patient is a 78-year-old male with a history of alcohol dependence who was admitted for an intraventricular bleed and developed new onset of refractory seizures.
  
  
  METHODS
  Intravenous pyridoxine followed by oral pyridoxine.
  
  
  RESULTS
  In all 3 cases, seizures persisted despite escalation of conventional antiepileptic medications but resolved within 2 days of pyridoxine supplementation. In each case, low serum pyridoxal 5'-phosphate concentrations normalized with pyroxidine administration.
  
  
  CONCLUSIONS
  Although refractory seizures caused by vitamin B(6) deficiency are rare in adults, it should be considered in critically ill adult patients with refractory seizures.
authors.affiliation: Ohio State University Medical Center, Columbus, Ohio, USA. Gerlach.6@osu.edu
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Sheela
authors.initials: S
authors.lastname: Thomas
authors.forename: Stanislaw P
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Whitmill
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
mesh_terms: D000368:Aged; D004351:Drug Resistance; D006801:Humans; D008297:Male; D008875:Middle Aged; D011732:Pyridoxal Phosphate / Q000097:blood*; D011736:Pyridoxine / Q000097:blood / Q000627:therapeutic use*; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D026681:Vitamin B 6 Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D014803:Vitamin B Complex / Q000097:blood / Q000627:therapeutic use*
chemical_list: D014803:Vitamin B Complex; D011732:Pyridoxal Phosphate; D011736:Pyridoxine